Boulos Dental Care, P.C.

Boulos Dental Care, P.C. was paid $112K by Medicaid between Nov 2019 and Dec 2024, across 5 billing codes. Its largest line is D1110, Prophylaxis - adult — 50% of everything it billed.

33Billing provider infoBOULOS DENTAL CARE, P.C.
SHOREVIEW, MN 55126

33aNPI1023308392assigned 04/07/2011

33bProvider typeExclusive Provider Organization

28Total paid$112K

24GClaims2,692

24DCodes billed5

24AFirst – last monthNov 2019 – Dec 2024

Compared with peers

Next to other Exclusive Provider Organization providers in Minnesota

Rank by total paid#10 of 12

Median peer was paid$3.02M

This provider vs. median0.0×

Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2019	67	$3K
2020	591	$21K
2021	809	$28K
2022	456	$23K
2023	399	$20K
2024incomplete	370	$18K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	50%	998	991	$56K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	30%	1,062	1,054	$33K
D0274	Bitewings - four radiographic images	18%	530	527	$20K
D1206	Topical application of fluoride varnish	1.7%	72	70	$2K
D0220	Intraoral - periapical first radiographic image	<1%	30	30	$366.48

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.

From NPPES

Who's on the registration

Authorized officialBOULOS, SAMY (DENTIST (DDS))